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1. Hypothermia
By ahmed c1

2. DEFINITION
•internal temperature <358C [<958F] (by
rectal, tympanic, or esophageal
thermometer).
•Hypothermia may be mild(34 358C [93
958F]), moderate (30 348C[86 938F]), or
severe (<308C [<868F])

3. CAUSES
INCREASED HEAT LOSS
ENVIRONMENTAL ; cold exposure
DERMATOLOGIC ; burns, extensive
psoriasis, vasodilation (drugs, alcohol,
sepsis, pancreatitis)
IATROGENIC cold fluid infusion, CPR,
renal replacement therapy

4. ALTERED REGULATION
•CENTRAL :
stroke, Parkinson’s disease,
multiplesclerosis, hypothalamic dysfunction,
anorexia nervosa,
drugs (barbiturate, TCA, sedatives, alcohol)
•PERIPHERAL
neuropathies, diabetes

5. DECREASED METABOLISM
•ENDOCRINE
hypothyroidism, hypopituitarism, adrenal
insufficiency, hypoglycemia
•METABOLIC
anorexia nervosa, malnutrition

6. RISK FACTORS
•extremes of age,
•alcoholism,
•malnutrition, homelessness,
• mental illness

7. HISTORY
exposure to cold (duration, environment)
shivering,
confusion,
delirium,
palpitations,
weakness, ulcers, frostbite, fever, weight loss,
past medical history (hypothyroidism,
diabetes,alcoholism, psoriasis),
medications,
social history

8. Physical examination
vitals(bradycardia,apnea,hypertension/
hypotension,hypoxemia),
respiratory and cardiovascular examination
(arrhythmia),
skin examination (frostbite, burns, psoriasis)
GCS(rigidity, hyporeflexia),

9. INVESTIGATIONS
BASIC
•LABS
CBC, lytes, urea, Cr, glucose, CK, troponin,
AST, ALT, ALP, bilirubin, TSH, urinalysis,
blood cultures
•ECG Osborn wave (elevated J point),
prolonged RR, PR, QRS, and QT intervals

10. COMPLICATIONS
hypothermia affects most organs,
causing cognitive (coma),
neuromuscular(rigidity),
respiratory (pulmonary edema),
cardiac(arrhythmia), and
cutaneous complications (frostbite).
Sepsis, pneumonia, hypokalemia,
hypoglycemia, and rhabdomyolysis may
also occur

11. MANAGEMENT
•ABC, O2 to keep sat >94%, IV. Caution
with fluid overload (decreased cardiac
output in hypothermic patients) and
vasopressors (arrhythmogenic potential).
•Resuscitation should continue until patient
completely rewarmed

12. MONITORING
continuous cardiac monitoring. Also
closely monitor electrolytes and glucose.
Vagotonic maneuvers (e.g. intubation or
suctioning) may precipitate asystole

13. •REWARMING environment (remove cold
clothing. Warming blanket). Active
rewarming (warm IV fluids 40 428C [104
1088F]. If severe hypothermia,consider
colonic/bladder irrigation, peritoneal or
pleural lavage, extracorporeal blood
rewarming.
•Goal of rewarming is 0.5 28C/h [1.88F/h]
to minimize risk of VF and hypovolemic
shock)

14. FROSTBITE
supportive care. Skin grafting and
amputation may be required if gangrene
develops

15. SPECIFIC ENTITIES
ELECTRICAL INJURY
Causes include
lightening,taser, and stun gun
injuries may involve
the skin(burns), heart (VF, asystole, cardiac
contusion),bones/muscles (deep
electrothermal tissue injury,osteonecrosis,
compartment syndrome, rhabdomyolysis
with renal failure, posterior shoulder
dislocation),

16. •and neurologic system (loss of
consciousness, weakness or paralysis,
respiratory depression, autonomic
dysfunction)

17. DIAGNOSIS clinical. Obtain CBC, lytes,
urea, Cr,glucose, CK, appropriate imaging,
drug and alcohol levels, urinalysis, CXR,
ABG, ECG
TREATMENTS
ABC, O2, IV. Supportive management of
complications. Monitor for compartment
syndromes. Psychiatry consult for post
traumatic stress disorder

18. SUBMERSION INJURY(drowning)
cause of drowning
•(accidental, suicidal, alcohol or illicit drug
use,concomitant myocardial
infarction/stroke).
•Complications include respiratory failure,
ARDS,hypothermia, arrhythmia (atrial
fibrillation, bradycardia, ventricular
tachycardia), acidosis (metabolic,
respiratory), anoxic brain injury,
cerebraledema, and seizures

19. DIAGNOSIS clinical. Obtain CBC, lytes,
urea, Cr,glucose, osmolality, drug and
alcohol levels, urinalysis, CXR, ABG, and
ECG
TREATMENTS
• ABC, O2, IV. Supportive management of
complications. 75% of near drowning victims
survive

20. Hyperthermia
•Heat related illnesses (Heat cramp,
exhaustion, stroke…)
•Malignant hyperthermia
•Neuroleptic malignant syndrome
•Hormonal hyperthermia
•Therapeutic hyperthermia
•Miscellaneous causes of hyperthermia